DHCF MMIS Enterprise Re-procurement Strategy And Planned Timeframe Presentation for Stakeholders Department of Health Care Finance July 2015 Washington DC

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

CMS Adopts New Strategy For Design Of Medicaid MMIS Requirements Historical Approach Purchase one claims processing system with multiple subsystems from one vendor CMS rejected DC’s proposed traditional approach in Feb. 2014 Lessons Learned Monolithic systems proven to be very costly – time & money Slow return on investment Few vendors / captive market New CMS Strategy for MMIS Re-procurement Break MMIS into modules Implement modules separately New MMIS must be implemented by Sept. 1, 2018 3

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

DHCF’s Current System Is A Single-Vendor Model Developed And Operated By Xerox External Systems to the MMIS Existing Xerox MMIS CORE Offering MCO Enrollment Broker Enrollment Data Paper Claims Electronic Keying System MMIS Web Portal QIO PA Data Entry Claims - Provider Reference - Financial Recipient - Prior Auth TPL - Managed Care Pharmacy Encounter Data Electronic Document Management System Electronic Fraud Detection System PBM Transportation Broker Enrollment Data ACEDs/ DCAS Correspondence Tracking System Case Management Recipient Eligibility Data EHR Provider Payment & Eligibility Data 4

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

The New Design Recommended By CMS Consists of Five Modules Data Warehouse Provider Data Management System Case Management System Prior Authorization System New MMIS CORE 5

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

The Design For DC’s New MMIS Core System Paper Claims Electronic Keying System MMIS Web Portal NEW MMIS System Correspondence Tracking System Claims - Reference – Financial - Recipient – TPL - Managed Care Electronic Document Management System 6

Financial - Recipient - DC’s Future MMIS Enterprise MCO Enrollment Broker Enrollment Data New MMIS CORE Offering QIO PA Data Entry Paper Claims Electronic Keying System MMIS Web Portal Pharmacy Encounter Data PBM Provider Data Management System Claims - Reference – Financial - Recipient - TPL - Managed Care Provider Enrollment Data Case Management System Recipient, Provider, PA, & Eligibility Data Electronic Document Management System Correspondence Tracking System Transportation Broker Enrollment Data DCAS Recipient Eligibility Data EHR Provider Payment & Eligibility Data 7

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

DC MMIS Re-procurement FAQ’s Question: Will the District wait until the system is fully integrated before going live or will different modules be operationalize at different times? Response: The District intends to operationalize and integrate each individual module once the module has passed user acceptance testing and operational readiness testing. Question: Is DHCF looking for one company that can deliver all components or will there be use separate companies with an integrator? What are the pros and cons of using one or multiple vendors? Response: The District intends on getting a best-of-breed vendor for each module. Therefore, the desire is to have multiple companies. No integrator will be needed because communication between the systems occurs in batch mode versus real-time. 8

DC MMIS Re-procurement FAQ’s (continued) Single Vendors Multiple Vendors Pros Less vendor management for the District post contract award Potentially less integration work needed between MMIS modules Cons No best of breed for each module Less vendor / product options Potentially higher price per module Less visibility for the District between MMIS enterprise modules Pros Best of breed for each module More vendor / product options Potentially lower price per module More visibility for the District between MMIS enterprise modules Cons More vendor management for the District post contract award Potentially more integration work needed between MMIS modules 9

DC MMIS Re-procurement FAQ’s (continued) Question: Will the District develop each of the RFPs internally for each module or will any outside resources be used to assist with RFP creations? Response: The District will utilize internal resources to craft the RFPs for MMIS solicitation. Question: What are the integration plans for the existing SAS Analytics system and the new MMIS Response: The SAS system will continue to operate in conjunction with the new MMIS implementation. Any integration requirements will be provided in the RFPs 11

Presentation Outline CMS Requirements Current DC MMIS Enterprise Recommended MMIS Enterprise Modules DC’s New MMIS Core System / Enterprise DC MMIS Re-procurement FAQ’s Timeline 2

DC’s Future MMIS Enterprise Timeline (DISCLAIMER: THE DATES AND TIMELINES BELOW ARE SUBJECT TO CHANGE WITHOUT NOTICE) 11